In right lobe (RL) living donor liver transplantation (LDLT), portal vein (PV) variations are of immense clinical significance. In this study, we describe in detail our PV reconstruction techniques in RL grafts with variant PV anatomy and evaluate the impact of accompanying biliary variations on the recipient outcomes. In a total of 386 RL LDLTs performed between July 2004 and July 2012, the clinical data on 52 (13%) transplants using RL grafts with variant PV anatomy were retrospectively analyzed. Portal vein anatomy was classified as type 2 in 20 patients, type 3 in 24 patients, and type 4 in eight patients. The PV reconstruction techniques utilized included back-wall plasty (n = 21), back-wall plasty with saphenous vein graft interposition (n = 6), saphenous vein graft interposition (n = 5), cryopreserved iliac vein Y-graft interposition (n = 6), and quiltplasty (n = 3). There was no donor mortality. In a median follow-up of 29 months, none of the recipients had vascular complications. Anomalous PV anatomy was associated with a high (54%) incidence of biliary variations; however, these variations did not result in increased biliary complication rate. Overall, the 1-and 3-year patient survival rates of recipients were 91% and 81%, respectively. Vascular and biliary variations in RL grafts render LDLT technically more challenging. By employing appropriate reconstruction techniques, it is possible to successfully use RL grafts with PV variations without endangering recipient and donor safety.
Identification of more than one biliary orifice in the graft resulted in an increase in the complication rates. In grafts containing multiple orifices, performing multiple duct-to-duct (DD) or Roux-en-Y anastomoses led to a lower number of complications.
Study objective: Anxiety disorder, which is encountered in surgical patients receiving general anesthesia is a psychological and physical condition, characterized by sudden onset of hazard perception and extensive fear, and may lead to panic disorder. In this study, we aimed to determine anxiety levels of liver transplantation donors via a questionnaire and reveal their quality of life and anxiety status during the 1 st postoperative day and month. Design: Prospective observational study. Setting: In the critical care. Patients: Following the Ethics Committee approval, forty subjects of both sexes, between the ages of 18 and 75 years, who were on the list of liver transplant donors were included in the study. Interventions: A 10-item anxiety and quality of life questionnaire was prepared using scales applied to surgical patients, such as the Amsterdam Preoperative Anxiety and Information Scale for preoperative anxiety, the Spielburger State-Trait Anxiety and Inventory and the Profile of Mood States on the 1st postoperative day and month. Measurements: Data regarding the donor's age, sex, marital status, educational background, history of previous surgeries, the degree of affinity between donor and the recipient, number and age of their children, and duration of patient's disease were recorded. Main results: On the first day and in the first month, the total score on questions "I am worried about anesthesia" was significantly lower than the total scores on the questions "I am worried about the success of the surgical procedure" and "I am worried about the risk of anesthesia-related mortality" (p = 0.007 and p = 0.001, respectively). Conclusions: Many living donors are motivated to make their decision on this procedure in a short time. We believe that allocating more time to informing patients and donors and holding information meetings on anesthesia and surgical procedures at intervals may be beneficial.
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